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The introduction of transesophageal echocardiography (TEE) in the mid-1980s extended the use of ultrasound to the intraoperative diagnosis and monitoring of cardiac and great vessel pathology. Intraoperative epicardial echocardiography has been used both as an adjunct to TEE, and as a primary diagnostic tool in patients with contraindications to TEE. The earliest applications of intraoperative epicardial imaging included the diagnosis of intracardiac pathology such as valvular heart disease. More recently, direct epivascular or epiaortic ultrasonographic (EAU) imaging of the ascending aorta and aortic arch has gained prominence as part of a multipronged intraoperative strategy to reduce atherosclerotic emboli. Although atheromatous disease of the descending aorta has been used to screen for disease in the ascending aorta, Konstadt et al. demonstrated that the interposition of the bronchus might prevent adequate visualization of the ascending aorta by TEE, making it unsatisfactory for a comprehensive atheroma evaluation. Furthermore, surgical palpation as a method of assessing atherosclerotic From the *Department of Anesthesiology, Emory University, Atlanta, GA; †Department of Anesthesiology, Duke University Medical Center, Durham, NC; ‡Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina; §Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York City, New York; Division of Cardiovascular Diseases, Scripps Clinic Medical Group, LA Jolla, California; ¶Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina; and #Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts. Accepted for publication January 15, 2008. Originally published in the Journal of The American Society of Echocardiography: J AM Soc Echocardiogr 2007;20:1227–35. Address correspondence and reprint requests to American Society of Echocardiography, 1500 Sunday Dr, Suite 102, Raleigh, NC 27607. Address e-mail to aprather@asecho.org. Copyright © 2008 Journal of The American Society of Echocardiography

anesthesia and analgesia/anesthesia and analgesia

Guidelines for the Performance of a Comprehensive Intraoperative Epiaortic Ultrasonographic Examination: Recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists; Endorsed by the Society of Thoracic Surgeons